Bowel Endometriosis

Bowel Endometriosis – Comprehensive Guide

What is Bowel Endometriosis?

Bowel endometriosis is a form of deep infiltrative endometriosis that occurs when endometrial tissue implants on the bowel wall. The rectosigmoid colon is most commonly affected.

How Does It Occur?

It develops through the spread of endometrial cells in the pelvic cavity and their invasion into the bowel wall. It is usually associated with advanced-stage endometriosis.

Symptoms

Increased painful defecation during menstruation, constipation, bloating, gas, rectal pain, and rarely blood in the stool are the most common symptoms.

Menstruation-Related Symptoms

The cyclic nature of symptoms (worsening with menstruation) is an important clue for bowel endometriosis.

How Is It Diagnosed?

Evaluation is performed with detailed anamnesis, physical examination, transvaginal ultrasound, and MRI. Colonoscopy usually does not show superficial lesions.

Ultrasound Findings

Hypoechoic nodules, wall thickening, and restricted mobility (negative sliding sign) may be observed in the bowel wall.

MRI Findings

T2 hypointense nodules, bowel wall thickening, and luminal narrowing may be seen. It plays a critical role in surgical planning.

Treatment Approach

Treatment is divided into medical and surgical approaches. While hormonal therapy provides symptom control, surgery may be required in advanced cases.

Surgical Treatment

Different techniques such as shaving, disc resection, or segmental resection can be applied. The surgical approach is determined by the depth of the disease.

Multidisciplinary Approach

In patients with bowel involvement, planning with general surgery is important.

Complications and Follow-up

Bowel functions should be monitored after surgery, and long-term follow-up for recurrence is necessary.

Conclusion

Bowel endometriosis is a complex disease. It can be successfully managed with accurate diagnosis, appropriate surgical technique, and a multidisciplinary approach.